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Effects of a school-based stroke education program on stroke-related knowledge and behaviour modification―school class based intervention study for elementary school students and parental guardians in a Japanese rural area
  1. Suzuka Kato1,
  2. Tomonori Okamura1,
  3. Kazuyo Kuwabara1,
  4. Hidehiro Takekawa2,
  5. Masanori Nagao3,
  6. Mitsumasa Umesawa3,
  7. Daisuke Sugiyama1,
  8. Naomi Miyamatsu4,
  9. Tenyu Hino5,
  10. Shinichi Wada5,
  11. Takuro Arimizu5,
  12. Toru Takebayashi1,6,
  13. Gen Kobashi3,
  14. Koichi Hirata2,
  15. Chiaki Yokota5,
  16. Kazuo Minematsu5
  1. 1 Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku, Tokyo, Japan
  2. 2 Department of Neurology, Dokkyo Medical Unversity, Mibu, Tochigi, Japan
  3. 3 Department of Public Health, Dokkyo Medical University, Mibu, Tochigi, Japan
  4. 4 Department of Clinical Nursing, Shiga University of Medical Science, Otsu, Shiga, Japan
  5. 5 Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  6. 6 Graduate School of Health Management, Keio University, Fujisawa, Kanagawa, Japan
  1. Correspondence to Prof. Tomonori Okamura; okamura{at}


Objectives This study aimed to determine the effect of a stroke education programme on elementary school students and their parental guardians in a rural area in Japan that has high stroke mortality.

Design School class based intervention study.

Setting Eleven public elementary schools in Tochigi Prefecture, Japan.

Participants 268 students aged 11–12 years and 267 parental guardians.

Interventions Students received lessons about stroke featuring animated cartoons and were instructed to communicate their knowledge about stroke to their parental guardians using material (comic books) distributed in the lessons. Stroke knowledge (symptoms, risk factors and attitude towards stroke) and behavioural change for risk factors were assessed at baseline, immediately after the programme and at 3 months. We also evaluated behavioural change for risk factors among parental guardians.

Results The percentage of students with all correct answers for stroke symptoms, risk factors and the recommended response to stroke was significantly increased at 3 months P<0.001). We observed a significant increase in the percentage of guardians who chose all correct symptoms (P<0.001: 61.0% vs 85.4%) and risk factors (P<0.001: 41.2% vs 59.9%) at 3 months compared with baseline. The percentage of parental guardians with a high behavioural response to improving risk factors was significantly increased at 3 months compared with baseline (P<0.001).

Conclusions In a rural population with high stroke mortality, stroke education can improve knowledge about stroke in elementary school students and their parental guardians.

Ethics and dissemination We conducted the intervention as a part of compulsory education; this study was not a clinical trial. This study was approved by the Ethics Committee of the National Cerebral and Cardiovascular Center (M27-026).

  • stroke
  • health behavior
  • health education

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  • Contributors TO, CY and KM designed this study. SK, TO, KK, HT, MN and MU visited participating elementary schools and instructed students on stroke knowledge. SK analysed the data in our study and wrote the first draft of the manuscript. TO, KK, HT, MN, MU, DS, NM, TH, SW, TA, TT, GK, KH, CY and KM commented on the draft manuscript.

  • Funding This research was supported by the Intramural Research Fund of the National Cerebral and Cardiovascular Center (27-1-3) .

  • Competing interests None declared.

  • Ethics approval This study was approved by the Ethics Committee of the National Cerebral and Cardiovascular Center (M27-026).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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